Provider Relations & Network Liaison

American Health Partners; Ashland (KY); Hybrid; USD 60,000 - 85,000; Full time

Benefits offered by this job

Affordable Medical/Dental/Vision保险选项

Paid time off and paid holidays for FT

TeleDoc 24/7/365 access to doctors

Disability plans (short- & long-term)

Employee Assistance Plan (EAP)

401K retirement accounts

Employee Referral Bonus Program

Job summary

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc., seeks a Provider Relations/Network Development professional to contract providers and vendors, ensure credentialing compliance, and educate the health plan’s providers about CMS requirements and processes.

This role involves travel to network provider locations, requires strong negotiation and communication skills, and offers a collaborative team environment with opportunities to contribute to process

Qualifications

• Must be fluent in all current provider payment methodologies including per diems, DRGs, and APCs.
• Knowledge of medical services levels and ability to rapidly develop working relationships.
• Ability to work independently to meet goals and assignments.
• Strong negotiation, organization, presentation and time management skills.
• Excellent communication with all levels of medical staff to explain Health Plan program, benefits and goals.

Responsibilities

• Contract providers and essential vendors to maintain CMS adequacy and provide necessary services for Plan members.
• Ensure credentialing requirements are met for service lines in current areas.
• Educate providers on Health Plan functions and CMS requirements.
• Provide ongoing educational updates as prescribed by CMS and Health Plan policies.
• Conduct educational presentations to ensure provider understanding and commitment to Health Plan.

Skills

Provider payment methods

Medical services knowledge

Independent work

Negotiation

Communication skills

Team player

MS Office

Self-motivation

Education

Bachelor's degree

Tools

Microsoft Office Suite

Job description

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc., seeks a Provider Relations/Network Development professional to contract providers and vendors, ensure credentialing compliance, and educate the health plan’s providers about CMS requirements and processes.

This role involves travel to network provider locations, requires strong negotiation and communication skills, and offers a collaborative team environment with opportunities to contribute to process